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世界核心医学期刊文摘（神经病学分册） 2005年第11期1卷 37-37页

作者： úgren-Wilsson A. Eklund A. Koskinen L.-O.D. 刘凯 Dr.Department of Clinical Neuroscience Ume University S-901 85 Ume Sweden

Background: The symptoms in idiopathic adult hydrocephal-us syndrome (IAHS) are consistent with pathology involving the periventricular white matter, presumably reflecting ischaemia and CSF hydrodynamic disturbance. Objective: To investigate whether a change in intracranial pressure (ICP) can affect energy metabolism in deep white matter. Methods: A microdialysis catheter, a brain tissue oxygen tension probe, and an ICP transducer were inserted into the periventricular white matter 0-7 mm from the right frontal horn in 10 patients with IAHS. ICP and intracerebral PtiO2 were recorded continuously during lumbar CSF constant pressure infusion test. ICP was raised to pressure levels of 35 and 45 mm Hg for 10 minutes each, after which CSF drainage was undertaken. Microdialysis samples were collected every three minutes and analysed for glucose, lactate, pyruvate, and glutamate. Results: When raising the ICP, a reversible drop in the extracellular concentrations of glucose, lactate, and pyruvate was found. Comparing the values during baseline to values at the highest pressure level, the fall in glucose, lactate, and pyruvate was significant (p < 0.05, Wilcoxon sign rank). There was no change in glutamate or the lactate to pyruvate ratio during ICP elevation. PtiO2 did not decrease during ICP elevation, but was significantly increased following CSF drainage. Conclusions: Raising intracranial pressure induces an immediate and reversible change in energy metabolism in periventricular white matter, without any sign of ischaemia. Theoretically, frequent ICP peaks (B waves) over a long period could eventually cause persisting axonal disturbance and subsequently the symptoms noted in IAHS.

关键词：丙酮酸盐额叶灰质缺血症状脑白质脑室周围白质符号秩检验前角持续性

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